Written by Jewels Doskicz, RN, BA | Reviewed by Sophie Vergnaud, MD Updated on December 20, 2022
Key takeaways:
- High blood sugar (hyperglycemia) can be a side effect of some common medications.
- In some cases, high levels of blood sugar are temporary and settle when someone stops the medication. But medications can increase the risk of developing Type 2 diabetes.
- If your medications cause high blood sugars, you may need to closely check your levels. If you have diabetes, you may need to adjust your medication in the short term. People without diabetes may need to start taking diabetes medications.
- Common symptoms of high levels of blood sugar range from increased thirst, urination, and hunger to weight loss and fatigue.
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Hyperglycemia, or a high level of blood glucose (blood sugar), is common in people with diabetes. It’s not good for you, and it’s the reason that people with diabetes need to pay attention to how they eat and exercise. It’s also why they may need to take regular medication when diet and exercise aren’t enough.
In normal situations, the body is really good at keeping blood glucose levels within safe limits. It’s very unusual for otherwise healthy people to have blood glucose levels that are too high or too low.
But certain drugs can raise blood sugar levels — including some very common ones. Sometimes, the increase in blood sugar is temporary and goes away when the medication is stopped. But medications can also increase the risk of developing Type 2 diabetes in people who don’t have diabetes yet.
That’s not always a big deal. Sometimes the increased risk is so small it doesn’t actually outweigh the benefits of taking the medication in the first place. But high blood glucose levels can become a problem. When that happens, there can be some easy fixes, like changing the medication or adding diabetes medications. Whatever the outcome, it’s helpful to know the risks and have a plan for what to do if blood glucose levels creep up.
1. Prednisone and other corticosteroids
Steroids, like prednisone, are used to treat inflammation in lots of conditions, from rheumatoid arthritis and asthma to COPD and inflammatory bowel disease. Steroids — either as pills or injection — can raise blood sugar levels while you’re taking them (this is much less likely with inhaled steroids). This can be a problem in people who already have diabetes and in people who don’t have diabetes.
Increased blood sugar is more likely if you take higher doses of steroids over the long term. It’s also more common in people with risk factors for diabetes. This includes people with a family history of diabetes, older adults, and people with prediabetes or previous diabetes in pregnancy. Glucose levels typically go back to baseline when you stop taking steroids or when you cut them back to lower doses.
2. Atenolol, metoprolol, and propranolol
Atenolol, metoprolol, and propranolol are beta blockers that treat heart problems like irregular heart rates and high blood pressure. But they can increase blood glucose in people with diabetes and cause new Type 2 diabetes in people who didn’t have it before. This seems to happen because the beta blockers reduce how much insulin the pancreas makes.
But not all beta blockers do this. Carvedilol (Coreg) and nebivolol (Bystolic) do not affect blood sugar levels or cause diabetes.
3. Hydrochlorothiazide and metolazone
Some other blood pressure medications, such as thiazide diuretics and thiazide-like diuretics, can have a similar effect. Like beta blockers, hydrochlorothiazide (HCTZ) and metolazone can increase blood sugar levels. They can also cause new Type 2 diabetes in as little as 9 to 18 weeks.
This seems to be more common the longer someone takes the medication. This also happens more often in people who have a higher risk of Type 2 diabetes. It’s not clear exactly how it happens, but it’s likely to be related to insulin production and how well the body responds to that insulin.
4. Simvastatin, atorvastatin and rosuvastatin
Regular use of statins — medications that treat high cholesterol — may cause a small increase in glucose levels in certain people. Statins seem to cause cells in the body to become resistant to insulin, the hormone that helps move glucose out of the blood and into cells.
The risk is higher in people who take larger doses of statins, like 40 mg to 80 mg atorvastatin (Lipitor) or 20 mg to 40 mg rosuvastatin (Crestor) and simvastatin. The risk is also higher for older adults, people with risk factors for diabetes, and people who already have prediabetes.
For most people, especially those who already have diabetes, the benefit of taking statins far outweighs the small increased risk of Type 2 diabetes.
5. Quinolone antibiotics, like gatifloxacin
One class of antibiotics — quinolones — has been linked to new onset Type 2 diabetes. This is most common with the quinolone antibiotic gatifloxacin. But there’s also a weaker link with levofloxacin. And it can happen fast — as quickly as 5 days into treatment.
It’s probably best to avoid these antibiotics if you’re older and have other risk factors for Type 2 diabetes. Other quinolones, like ciprofloxacin and moxifloxacin, do not seem to have this effect.
6. Leuprolide and goserelin
Many men with prostate cancer get androgen deprivation therapy with medications like Lupron (leuprolide), Zoladex (goserelin), Trelstar (triptorelin), or Firmagon (degarelix). But their use has been linked to a significantly increased risk of developing Type 2 diabetes. The risk comes from an increase in body fat along with a decrease in muscle mass, a change in blood fat and cholesterol levels, and insulin resistance.
7. Antipsychotics, like olanzapine and clozapine
Newer antipsychotics, like clozapine and olanzapine, cause an increase in blood sugar levels in people with diabetes and increase the risk of getting new Type 2 diabetes. This is most likely because they cause weight gain. But this link hasn’t been seen with all antipsychotics. Risperidone and quetiapine (Seroquel) cause an increase in body weight but no increase in diabetes.
8. Protease inhibitors to treat HIV
Protease inhibitors are one of six major classes of antiretroviral therapies for people with HIV/AIDS. Unfortunately, they have a long history of being linked to weight gain, metabolic syndrome, raised blood sugar levels, and new diabetes.
In people with other risk factors for diabetes, it’s probably a good idea to avoid medications like atazanavir, darunavir, and ritonavir.
Luckily, there are many alternatives to protease inhibitors now. Other classes of medications, like integrase strand transfer inhibitors (INSTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI), do not cause diabetes and high blood sugar levels. Examples of INSTIs are raltegravir, elvitegravir, dolutegravir, and bictegravir. Examples of NNRTIs include efavirenz and nevirapine.
9. Some immunosuppressants, like cyclosporin, sirolimus, and tacrolimus
Calcineurin inhibitor medications, like cyclosporine, sirolimus, and tacrolimus, are commonly used medications after organ transplants. They have been linked to an increased risk of diabetes, especially in older adults and those who also take steroids. As many as ¼ of people develop new diabetes in the 3 years after a kidney transplant.
Should you avoid these medications if you have diabetes?
If you have diabetes, taking medications that affect blood sugar levels can make it harder to stay within your target range. Your healthcare provider can help you manage this. But, before starting new medications, it’s always worth reminding your prescriber and pharmacist that you have diabetes.
If the treatment is necessary, you may need to take more of your diabetes medication during that treatment.
When to talk to your healthcare provider
It’s never too early to talk to your healthcare provider about hyperglycemia if you’re taking any of these medications. By being aware of the risk, you’ll be able to take steps early to reverse high blood sugar caused by medications.
If you’re at risk for Type 2 diabetes, your healthcare provider can order regular blood glucose testing to make sure that your treatment stays safe for you.
If your blood sugar levels creep up, you may need to make adjustments to your medications. This may mean taking a lower dose or switching to a different medication. In some cases, you may need treatment for high blood glucose.
The bottom line
High blood glucose, or hyperglycemia, is when there’s too much glucose in the blood. It’s typical in diabetes, and certain medications can cause it. If you’re taking any medications that raise blood sugar, your healthcare provider can set up a monitoring plan — especially if you have diabetes or risk factors for diabetes. Regular glucose testing can help you stay ahead of the problem and take action early.
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